tbuckley/cabot-search huggingface dataset:
POS0757 UVEITIS AS PREDICTORS OF RELAPSE AFTER ANTI-TNF TREATMENT WITHDRAWAL IN JUVENILE IDIOPATHIC ARTHRITIS: AN ITALIAN MULTICENTRIC EXPERIENCE
Authors: I. Maccora, M. Trevisan, V. Accardo, I. Pagnini, F. La Torre, E. Marrani, M. Cattalini, M. V. Mastrolia, A. Taddio, G. Simonini
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. TNF inhibitors (TNFi) have dramatically changed the prognosis of this disease, but once achieved disease remission, it is not clear how and when stop therapy. <h3>Objectives</h3> Our purpose is to describe a multicentric cohort of JIA patients treated with the first course of Adalimumab and Etanercept in whom therapy was discontinued to persistent remission and identify predictors of relapse. <h3>Methods</h3> In a multicentric Italian retrospective study (Florence, Brescia, Trieste and Bari), patients with oligoarticular and polyarticular JIA were enrolled if they stopped therapy for persistent remission after the first course of Adalimumab and Etanercept. We collected demographic, clinical and laboratory data at onset and during biologic treatment. <h3>Results</h3> 136 patients were enrolled (102 female, median age at onset 3 years (R1-15)), of whom 76 (55.9%) had oligoarticular JIA and 55 (40.4%) had uveitis. ANA positivity was found in 99(72.8%) (Table 1). TNFis were started at median age of 6 years (R1-16), with a median time intercourse between TNFi initiation and diagnosis of 12 months (0-127m). Seventy-nine (59.3%) were treated with ADA, and 57 (40.7%) with ETA. Remission was achieved after a median time of 4 months (R 1-32) and TNFi was discontinued after a median time of 30 months (R 6-90). TNFi were stopped in the 76.5% increasing the interval of administration, 18.4% reducing the dose, and 16.9% abrupt discontinuation. 106 patients (79.4%) relapsed after a median time of 6 months (R 0.5-96) for arthritis in 71 (66.9%), uveitis in 19 (17.9%), both in 18 (16.9%). Patients who relapsed were more frequently female (χ² 5.9 p&lt;0.014), had history of uveitis (χ² 7.4 p&lt;0.006), younger at onset (median 3 vs 7, p&lt;0.001) and when TNFi was started (6 vs 9.5, p 0.002). Moreover, the time intercourse between diagnosis and TNFi initiation was longer (13 vs 8.5 months, p 0.02) and the weaned of therapy happened in shorter time (6 vs 9 m, p 0.005) (Table 1). Patients who not-relapse suspended TNFi more frequently lengthening intervals of administration (χ² 5.2 p0.015). Relapse free survival curve after withdrawal evaluated with Kaplan-Meier showed that patients with uveitis had a significantly earlier relapse (Log Rank χ² = 12.8 p &lt;0.0001) <h3>Conclusion</h3> Although this is a retrospective study, we highlighted that early age at onset and at TNFi initiation, presence of uveitis and a long time to start biologics seem to be significantly more frequent in subjects who relapse, while stop therapy lengthening the interval of drug administration might be protective. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
A New Antiviral Option for Cytomegalovirus Prevention After Kidney Transplant
Authors: Zoe Raglow, Daniel R. Kaul
Journal: JAMA (2023)

Ajit P. Limaye, MD; Klemens Budde, MD; Atul Humar, MD, MSc; Flavio Vincenti, MD; Dirk R. J. Kuypers, MD, PhD; Robert P. Carroll, BM, BCh, DM; Nicole Stauffer, BS; Yoshihiko Murata, MD, PhD; Julie M. Strizki, PhD; Valerie L. Teal, MS; Christopher L. Gilbert, BS; Barbara A. Haber, MD
POS0837 IMPACT OF JAKI, TOFACITINIB, ON CV RISK IN RHEUMATOID ARTHRITIS: JAKI CV RISK IMPACT STUDY
Authors: A. Syngle, I. Verma, N. Garg, K. Chauhan, S. Patyal, V. Syngle
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Cardiovascular disease, that includes CAD &amp; Stroke, is the leading cause of premature mortality and sudden death in RA. Classical CV risk &amp; disease specific risk factors all contribute to the enhanced CV risk in RA. Endothelial dysfunction (ED), the " sine qua non" for atherosclerosis appearance, is the key promoter of CVD. ED is a barometer for CV health and a seminal target for reducing cardiovascular (CV) risk in RA. Given the magnitude of the problem, therapeutic armamentarium for CV risk reduction in RA is limited. <h3>Objectives</h3> To prospectively investigate the impact of Tofacitinib (TOFA) on CV risk in active RA. <h3>Methods</h3> 81 consecutive RA patients (Table 1) meeting 2010 Rheumatoid Arthritis Classification Criteria median age 54 years, 81% female, disease duration 14 years, moderate to high activity (DAS28-5.3) who were non-responders to MTX at least 15 mg/week and/or other synthetic DMARDs free of clinical overt cardiovascular disease were randomized 1:1 to receive TOFA 5 mg bid (n=41) or placebo (n=41) for 12 weeks as an adjunct to existing stable antirheumatic drugs. Primary endpoints included endothelial dysfunction assessed by Flow Mediated Dilatation (FMD), using Angiodefender, at baseline and after 12 weeks of treatment and occurrence of MACE and VTE throughout the study. The secondary end points included: DAS28, ESR, CRP, HAQ-DI. <h3>Results</h3> At baseline, endothelial function was impaired and levels of inflammatory measures were elevated and HAQ-DI was impaired in both groups. After treatment, FMD improved significantly in the tofacitinib group from (6.64 ± 2.13 to 8.17 ± 2.69, p=0.0001) as compared to placebo (6.36 ± 3.01% to 6.84 ± 2.95%, p=0.68) (Figure 1A). DAS28 (Figure 1B), ESR and CRP levels improved significantly in tofacitinib group as compared to placebo (p≤0.05). TOFA significantly decreased HAQ-DI (Figure 1C) values as compared to placebo. There was no MACE or VTE event during the study period in either group. After 12 weeks of treatment, FMD increased by 23.04% where as DAS28, ESR and CRP decreased by 31.23%, 29% and 60% respectively in the TOFA group (Figure 1D). Significant negative correlation was observed between FMD and CRP (0.32, p≤0.05) before and after (r= -0.34, p≤0.05) treatment with TOFA whereas no such correlations were found in placebo group. <h3>Conclusion</h3> TOFA, apart from its anti-inflammatory activity, improves endothelial dysfunction and cardiovascular risk in active RA without clinical overt cardiovascular disease. Thus, JAK inhibition with TOFA has vasculoprotective and cardioprotective effect mediated through anti-inflammatory and probably other mechanisms. <h3>Reference</h3> [1]Adawi M, Watad A, Bagazzi NL et al. Endothelial function in rheumatoid arthritis. QJM: An International Journal of Medicine, 2018, 243–247. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0517 ANTINUCLEAR ANTIBODIES IN GOUT: VICTIMS OF MODERN IMMUNOLOGY TECHNIQUES (A NEW VOMIT)
Authors: A. M. Herrero-Beites, C. Vazquez-Puente, M. D. C. Modesto-Caballero, F. Perez-Ruiz
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Non-rational prescription of tests in clinical practice may induce inefficient performances, misdiagnosis, and inappropriate consultations. <h3>Objectives</h3> We analyzed the prescription and results of antinuclear antibodies (ANA) prescription before first consultation to a rheumatology unit in a disease with commonly high diagnostic accuracy based on clinical findings: gout. <h3>Methods</h3> In the decade 2013-2022 the prescription and results of ANA testing prior to first rheumatology visit was added to the database, along with general data and variables related to comorbid conditions and clinical characteristics of gout. We made an analysis of variables plausibly associated with ANA prescription and biennial changes through n the rate of prescription. <h3>Results</h3> From Jan 2013 to Dec 2022, 504 patients gave written consent for data inclusion, 66 (13.7%) women and 415 men (86.3%), with mean age at entrance in the cohort of 73±14 and 65±14 years, respectively. ANA had been prescribed to 114 (23.7%) subjects, in 28/66 (42.4%) women and 86/415 men (p&lt;0.001). No differences for prescription were observed in other variables, such as age, time from onset, flares per year, tophi, or polyarticular distribution. The rate of ANA prescription was not related to the diagnostic for consultation: arthralgia (24.4%), arthritis (21.7%) or gout (25.3%). 31/114 (27.2%) ANA tests were positive (90% with title &lt;1/400), but only led to a new diagnosis (autoimmune hepatitis), and two had a previous diagnosis (Sjögren´s Syndrome and Systemic Lupus). The rate of positive ANA was much higher in women (12/28, 42.9%) than in men (8/86, 22.1%). The rate of ANA prescriptions showed a biennial and significative increase during the last decade (p= 0.007): 11.3% in 2013-14, 21.4% in 2015-16, 34.9% in 1016-2017, and 31.1% in 2021-22. A valley in ANA prescriptions was observed during SARS-COV2 pandemia 2019-2020 (19.7%). <h3>Conclusion</h3> In a rheumatic disease with quite typical clinical presentation as gout, the rate of ANA prescription prior to rheumatology consultation is unexpectedly high, and the highest in women, despite old age and absence of systemic clinic. The rate of positive ANA in the elder in our setting is quite high, especially in women, and may lead to misdiagnosis and inefficient management: a new VOMIT. <h3>Acknowledgements</h3> Cruces Rheumatology Association. <h3>Disclosure of Interests</h3> Ana Maria Herrero-Beites: None declared, Cristina Vazquez-Puente: None declared, Maria del Consuelo Modesto-Caballero: None declared, Fernando Perez-Ruiz Speakers bureau: Menarini, Astellas, Consultant of: Arthriti, Alnylam, LG, Protalix, Selecta.
POS0469 BEHOLD THE WINDOW, MIND THE BUILDING! LONG-TERM BENEFITS FROM EARLY RHEUMATOID ARTHRITIS TREATMENT VANISHED UNDER REAL-LIFE CONDITIONS: RESULTS FROM THE REAL STUDY
Authors: A. De Afonseca Dias e Silva, L. Rebouças, C. Albuquerque, A. P. Gomides, N. De Carvalho Sacilotto, R. Giorgi, A. B. Vargas-Santos, S. Radominski, I. Pereira, M. F. Guimarães, M. Bertolo, P. Louzada, M. D. F. Sauma, K. Bonfiglioli, C. Brenol, F. Borghi, L. Mota, G. Da Rocha Castelar Pinheiro
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> In experimental settings, early treatment is associated with better outcomes in rheumatoid arthritis (RA), underpinning the concept of a "window of opportunity". Under real-life conditions, though, the long-term maintenance of such benefits is uncertain. <h3>Objectives</h3> To assess the long-term maintenance of expected clinical benefits associated with early RA treatment under real-life conditions. <h3>Methods</h3> Adults meeting the ACR/EULAR (2010) criteria for RA were included. The participants had long-standing disease, been followed up in 11 healthcare centers in Brazil as part of the REAL study. [1] Individuals whose treatment had been initiated within 6 months of disease onset were compared with those treated for the first time only later on. Disease activity (DAS28-CRP), physical function (HAQ) and the presence of erosive disease were evaluated. Chi-squared and t tests, along with logistic and linear regression were used to verify associations. p-values &lt; 0.05 were deemed significant. The study received ethical approval, and all participants gave informed consent. <h3>Results</h3> 995 participants were included; 89.6% female; 56% white. The mean (SD) age was 56.8 (11.6) years; cumulative schooling years: 8.1 (4.25). The median (IQR) disease duration was 147 (81–236) months. Rheumatoid factor was positive in 77.6%. The mean (SD) DAS28 was 3.28 (1.38); median (IQR) HAQ score: 0.750 (0.250–1.500). Erosive disease occurred in 54.2%. Table 1 compares early- vs. late-treated patients, showing small effect sizes in clinical outcomes. After adjusting for age, schooling years, disease duration and corticosteroid use, early treatment was no longer an independent predictor of DAS28 scores (β = 0.153; p = 0.160), HAQ scores (β = 0.023; p = 0.682) or erosive disease [Exp(β) = 0.926; p = 0.626]. <h3>Conclusion</h3> In long-standing RA, only small differences in disease activity, physical function and erosive disease were associated with early or late initial treatment. After adjusting for confounders, these differences vanished, indicating that beyond the "window" of opportunity lies a "building" of continued disease management, which might be of even greater relevance for the long-term outcomes in real-life settings. <h3>Reference</h3> [1]da Rocha Castelar-Pinheiro et al. The REAL study: a nationwide prospective study of rheumatoid arthritis in Brazil. Advances in Rheumatology (2018) 58:9. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0938 PROLONGED PHYSICAL STRAIN AT WORK CONFERS RISK FOR DEVELOPMENT OF RHEUMATOID ARTHRITIS IN PATIENTS WITH CLINICALLY SUSPECT ARTHRALGIA: CUES FOR MECHANICAL FACTORS AS FINAL PATHOPHYSIOLOGICAL HIT
Authors: B. Van Dijk, A. M. P. Boeren, S. Khidir, N. Den Hollander, A. Van der Helm – van Mil
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Some case-control studies have identified physical workload as a risk-factor for rheumatoid arthritis (RA). <h3>Objectives</h3> To better understand its influence on the pathophysiological trajectory of RA-development, we studied the relation of work-related physical strain with MRI-detected joint-inflammation in clinically suspect arthralgia (CSA) and the general population, and with progression from CSA to clinical arthritis. <h3>Methods</h3> 501 consecutively presenting CSA-patients and 155 symptom-free persons filled out questionnaires on their occupation. Physical strain was determined using the International Standard Classification of Occupations (ISCO) per subject-reported occupation. Contrast-enhanced hand-MRIs were evaluated for synovitis/tenosynovitis/osteitis (summed as joint-inflammation) using the RAMRIS-method. CSA-patients were followed on clinical arthritis development (median follow-up 25 months). Analyses included interaction with age as proxy for prolonged physical strain. <h3>Results</h3> In CSA-patients, the degree of physical strain was associated with the severity of subclinical joint-inflammation, independent of BMI/smoking/education-level: there was a positive interaction between age and physical strain; p=0.007. Plotting the age-dependent effects showed a positive relation in CSA-patients aged ≥50 years (Figure 1A), suggesting the effect relates to prolonged physical strain. Especially tenosynovitis was increased in relation to higher physical strain. Prolonged physical strain in symptom-free persons was not associated with MRI-detected joint-inflammation. Older (≥ 50 years) CSA-patients with higher physical strain developed clinical arthritis more often (Figure 1B; HR 1.17 (95%CI 1.00–1.35) per 10 percentage-points physical strain increase; p=0.043). This was partially mediated by subclinical joint-inflammation. Moreover, physical strain partially mediated the known association between low educational attainment and clinical arthritis development. <h3>Conclusion</h3> Prolonged work-related physical strain increases the risk of developing RA in CSA-patients, which is partially mediated by an effect on increased subclinical joint-inflammation. This points to mechanical factors as a final hit in the pathophysiology of RA-development. <h3>Acknowledgements</h3> We thank dr. B. Ravesteijn for sharing occupation-specific physical strain data (see Ravesteijn et al., Health Econ. 2018, and www.bastianravesteijn.com). <h3>Disclosure of Interests</h3> None Declared.
POS0928 DEEP LEARNING BASED ASSESSMENT OF SALIVARY GLAND ULTRASONOGRAPHY IMAGES FOR SUPPORTING THE DIAGNOSIS OF PRIMARY SJOGREN’S SYNDROME
Authors: Y. Geng, X. Zhang, Z. Zhang
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Salivary gland ultrasound (SGUS) has proven to be a promising tool for diagnosing primary Sjögren's syndrome (pSS). However, the widespread use of it as standardized diagnostic tools is limited by inter/intra operator variability. <h3>Objectives</h3> The aim of this study was to evaluate the utility of deep learning-based SGUS image assessment in the diagnosis of pSS. <h3>Methods</h3> Between Sep 2021 and Oct 2022, 1133 SGUS images of 137 patients from one center were included in this retrospective study. Among them, 61 patients with 480 images were diagnosed as pSS and 76 patients with 653 images were non-SS. All the SGUS image data were randomly divided into training dataset (50%), validation dataset (20%) and testing dataset (30%). The SGUS automatic classification model was developed by using a deep residual convolutional network architecture (RESNET). The predictive performance was validated by sensitivity, specifcity and area under reciver operating characteristic curve (ROC). <h3>Results</h3> When applying deep learning-based SGUS image assessment, it showed better performance than operator based SGUS score system by improving the specifcity (86.9% vs. 80.1%), while similar sensitivity (59.4% vs. 61.4%). The area under the ROC were comparable between them (0.800 vs 0.775). <h3>Conclusion</h3> Deep learning-based SGUS image assessment maybe an objective and promising tool compared to expert-based scoring of SGUS in the diagnosis of pSS. This may support SGUS as an effective and prospective diagnostic tool to supplement current diagnostic methods. <h3>References</h3> [1]Vukicevic AM, Milic V, Zabotti A, Hocevar A, De Lucia O, Filippou G, Frangi AF, Tzioufas A, De Vita S, Filipovic N. Radiomics-Based Assessment of Primary Sjögren's Syndrome From Salivary Gland Ultrasonography Images. IEEE J Biomed Health Inform. 2020 Mar;24(3):835-843. [2]Vukicevic AM, Radovic M, Zabotti A, Milic V, Hocevar A, Callegher SZ, De Lucia O, De Vita S, Filipovic N. Deep learning segmentation of Primary Sjögren's syndrome affected salivary glands from ultrasonography images. Comput Biol Med. 2021 Feb;129:104154. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0910 A MULTIPLEX RT-QPCR KIT FOR EXPRESSION ANALYSIS OF INTERFERON-STIMULATED GENES AS A USEFUL TOOL FOR MOLECULAR STRATIFICATION IN LUPUS AND OTHER AUTOIMMUNE DISEASES
Authors: J. Qian, L. Lu, Z. Cao, Q. Fu
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> It is recognized that the expression of interferon (IFN)-stimulated genes (IFN signature) plays a significant role in several autoimmune diseases (AIDs) [1], such as systemic erythematosus lupus (SLE), idiopathic inflammatory myopathies (IIM) and rheumatoid arthritis (RA). A quick and ready-to-use method to differentiate IFN activation state is clinically needed. <h3>Objectives</h3> This study aimed to conduct analytical validation of the Multiplex ISGs RT-qPCR Kit in clinical practice <h3>Methods</h3> We designed a multiplex RT-qPCR method to provide IFN score covering both type I IFN and type II IFN by simultaneously detecting the expression of 3 IFN stimulated genes (ISGs), IFI44, MX1(type I ISGs), and IRF1(type II ISG), relative to one housekeeping gene (HPRT1). Measurements were performed on mRNA extracted from the peripheral blood cells of patients with multiple AIDs. The relative expression of each target gene (T/R) was calculated via 2^-ΔCT. The T/R of each target gene was then normalized as the following: T/R <sub>subject</sub> - Mean <sub>HC</sub>/ SD <sub>HC</sub>. IFN score was calculated as the mean of the normalized T/R of three target genes. Scores higher than the mean of HC plus two SD were designated IFN score high; otherwise, IFN score low. Analytical validation was performed to assess compliance rate, accuracy and method detection limit. <h3>Results</h3> Significantly elevated IFN scores were found in SLE(n=116), IIM(n=118), and RA(n=17) compared to other AIDs and HC. Four distinct subpopulations of SLE patients were observed: Thirty-five percent of SLE patients exhibited elevation of all three genes, indicating both type I and type II IFN pathways were activated. 44% of SLE patients had elevated expression of type I ISGs but no change in the type II ISG suggesting only type I IFN pathway was activated. 15% SLE patients presented no elevated expression of ISG gene. And 6% SLE patients only showed increased expression of IRF1 without overexpression of other 2 Type I ISGs, suggesting they probably only had type II IFN pathway activated. We repeated the tests. The compliance rate was 100% and accuracy was 100% with a CV of 0.36%. The method detection limit was 0.61 ng/μL. <h3>Conclusion</h3> Using the Multiplex<sup>®</sup> ISGs RT-qPCR Kit, we assessed the IFN score in multiple AIDs. The analytical validation of the kit reveals that it is a reliable, reproducible diagnostic tool that will be useful in clinical practice but may require confirmation in larger-scale trials. <h3>Reference</h3> [1]L. Rönnblom, and M.L. Eloranta, The interferon signature in autoimmune diseases. Curr Opin Rheumatol 25 (2013) 248-53. <h3>Acknowledgements</h3> The authors thank the patients for participating in the study. <h3>Disclosure of Interests</h3> None Declared.
POS0969 PREDICTIVE FACTORS OF FAVOURABLE EVOLUTION IN GLUCOCORTICOIDS-DEPENDENT POLYMYALGIA RHEUMATICA
Authors: S. Boukhlal, S. Aghiles, N. Emmanuel, G. Carvajal Alegria, E. Dernis, C. Richez, G. Direz, I. Chary Valckenaere, M. E. Truchetet, D. Wendling, E. Toussirot, A. Perdriger, J. E. Gottenberg, R. Felten, B. Fautrel, L. Chiche, P. Hilliquin, C. Le Henaff Bourhis, D. Benjamin, A. Lohse, D. Guellec, T. Marhadour, P. Pochard, D. Cornec, A. Saraux, V. Devauchelle-Pensec
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The main treatment of polymyalgia rheumatica (PMR) are glucocorticoids (GC) with a 6-month decrease target, but 45% of patients have an unfavourable evolution with relapses or glucocorticoids dependence. Poor prognostic factors in PMR are understudied and controversial. <h3>Objectives</h3> The aim of this work was to identify predictive factors of favourable evolution in GC-dependent PMR patients to optimize its management. <h3>Methods</h3> This work used data from the phase III study SEMAPHORE, which compared tocilizumab with placebo in combination with a standardized decrease in oral GC in patients with GC-dependent PMR. Response to treatment was assessed at week 24 after 6 administrations of tocilizumab 8 mg/kg or placebo. The favourable outcome criterion was a PMR-AS &lt; 10 with a dose of glucocorticoids ≤ 5 mg/day of prednisone equivalent or a dose reduction of ≥ 10 mg/day between inclusion and week 24. The prediction of a favourable outcome based on the inclusion parameters was evaluated in univariate and then multivariate analysis for the variables with a p &lt;0.2 in univariate in the whole of the population and in both treatment arms (tocilizumab and placebo). <h3>Results</h3> At week 24, 49% of the 100 patients included had fulfilled the favourable outcome criterion. In the whole population, being treated with tocilizumab was the main predictor of favourable evolution (OR: 6.28 (2.49-17.27), p=0.0002). In the tocilizumab group, the absence of anemia, the absence of renal impairment and a low HAQ-DI at inclusion were predictive of favourable evolution (OR: 13.2 (1.62-166.5613.2), 8.78 (1.19-91.23) and 10.16 (2.03-78.66) respectively). No variable was related to favourable outcome in the placebo group. <h3>Conclusion</h3> In patients with an active disease despite GC, a favourable outcome was predict by tocilizumab treatment. In the population treated by tocilizumab, the absence of comorbidities such as anemia or renal impairment and a better functional activity with a low HAQ-DI were associated with favourable outcome. No predictive factors were identified in patients trated with GC only. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.